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CQC children's survey finds good care but highlights inequalities

British Journal of Family Medicine, July, 2015

While the “vast majority” of children who stayed in hospital overnight or were seen as a day patient were satisfied with the care they received, hospital stays are failing children with learning disabilities and mental health needs, a major new report by the CQC revealed.

In total, almost 19,000 children and young people took part in the survey. Most were happy with the care they received, felt staff did everything possible to control their pain and they understood the information given to them about their hospital visit.

However, children with learning disabilities, or mental health needs reported poorer experiences of care than those without.

The survey included results from 137 acute NHS trusts. It found:

Almost nine out of ten of all eight to fifteen year olds said that felt safe on the ward at all times

91% of parents or carers said they felt their child was always safe

80% of all eight to fifteen year olds said staff did everything they could to help control their pain

Almost three quarters of children and young people who have had surgery or a procedure received explanations about what had happened in a way that was easy for them to understand.

However, the survey also revealed areas which required work:

41% of parents and carers felt staff were not always aware of their child’s medical history before treating them

43% of 12 to 15 year olds said they were not fully involved in decisions about their care

35% of parents and carers said they were not definitely encouraged to be involved in decisions about their child’s care and treatment

Less than half the children between 8-15 (45%) liked the food on offer

32% of parents or carers said staff were not always available when their child needed attention

42% children aged 8-11 said staff did not play or do any activities with them while in hospital.

Additionally, responses were less positive across all areas that involved children with mental health conditions, learning or physical disabilities, compared to the children and parents or carers of children without these conditions. Here, the results revealed:

45% of parents and carers of children with physical disabilities and 49% of parents and carers of children with mental health conditions or learning disabilities thought staff were aware of their child’s medical history before caring for them or treating them, compared with 59% for parents or carers of children without these conditions

Less than half of parents and carers of children with a physical disability, mental health needs or a learning disability felt that staff definitely knew how to care for their child’s individual needs. This compares to 72% of parents and carers of children without these conditions.

Almost two thirds of parents and carers of children with a physical disability, and 68% of those with children with mental health needs or a learning disability, said the ward had appropriate equipment or adaptations suitable for their child, compared with 81% of parents and carers whose children did not have these needs.

Commenting on the findings, Professor Edward Baker, CQC’s Deputy Chief Inspector of Hospitals, said: “There is much to celebrate in our first survey to ask children and young people about their care.

“Nationally, most young people and children said they were happy with their care, are able to understand the information given by staff following an operation or procedure, and that they have confidence staff are doing everything they can to manage their pain.

“However, there is marked variation between the results from individual hospitals. We have now inspected the majority of children’s hospital services in England, and those inspections have also shown marked variation in the quality of care provided.

“We’re encouraging more children and young people to share their experiences of care with us, and along with our inspections, these are crucial to help drive improvements in the quality of children’s services.”

Jolanta Lasota, CEO at Ambitious about Autism said the findings were symptomatic of a wider problem regarding the understanding of special needs: “A hospital experience is traumatic for any child but it is even more so for those with special needs. A good understanding of the nature of learning disabilities such as autism is vital in knowing how to treat someone on the autism spectrum. Factors that might not be taken into consideration for others, such as sensitivity to physical contact, bright lights and loud noise, can all be extra factors that make a hospital experience more traumatic for those with autism.

“Parents and carers know their child better than anyone else so it is disappointing to see they don’t feel the understanding is there from those who look after their children. This is representative of a wider need for more understanding of the needs of those with special needs. Educating staff is the first step in solving this issue and we urge government to address this problem.”